A randomized controlled trial of the effectiveness of handheld computers for improving everyday memory functioning in patients with memory impairments after acquired brain injury.

OBJECTIVE: To determine the effectiveness of personal digital assistant devices on achievement of memory and organization goals in patients with poor memory after acquired brain injury. DESIGN: Assessor blinded randomized controlled trial. SETTING: Specialist brain injury rehabilitation hospital (inpatients and outpatients). PARTICIPANTS: Adults with acquired brain impairments (85% traumatic brain injury; aged ≥17 years) who were assessed as having functional memory impairment on the Rivermead Behavioural Memory Test (General Memory Index). INTERVENTIONS: Training and support to use a personal digital assistant for eight weeks to compensate for memory failures by an occupational therapist. The control intervention was standard rehabilitation, including use of non-electronic memory aids. MAIN OUTCOME MEASURES: Goal Attainment Scale which assessed achievement of participants' daily memory functioning goals and caregiver perception of memory functioning; and General Frequency of Forgetting subscale of the Memory Functioning Questionnaire administered at baseline (pre-randomization) and post intervention (eight weeks later). RESULTS: Forty-two participants with memory impairment were recruited. Use of a personal digital assistant led to greater achievement of functional memory goals (mean difference 1.6 (95% confidence interval (CI) 1.0 to 2.2), P = 0.0001) and improvement on the General Frequency of Forgetting subscale (mean difference 12.5 (95% CI 2.0 to 22.9), P = 0.021). CONCLUSIONS: Occupational therapy training in the use of a handheld computer improved patients' daily memory function more than standard rehabilitation.

Validity and responsiveness of the care and needs scale for assessing support needs after traumatic brain injury.

OBJECTIVE: To investigate the validity and responsiveness of the Care and Needs Scale (CANS), which was designed to assess support needs of people with traumatic brain injury (TBI). DESIGN: Two samples of community clients (n=38, n=30) were recruited to examine concurrent, convergent/divergent, and discriminant validity. The ability of the CANS to detect change over a 6-month period from the time of inpatient rehabilitation discharge (predictive validity and responsiveness) was investigated in a third sample of 40 rehabilitation inpatients. SETTING: Two Brain Injury Rehabilitation Units in Sydney, Australia. PARTICIPANTS: People (N=108) aged between 16 and 70 years admitted for rehabilitation after TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The CANS, Supervision Rating Scale, FIM, Sydney Psychosocial Reintegration Scale, and Disability Rating Scale. RESULTS: Evidence for concurrent validity was shown with fair to moderate correlation coefficients between the CANS and measures of supervision, functional independence, and psychosocial functioning (absolute value, r(s)=.43-.68; P<.01). Support for convergent and divergent validity was provided by correlation coefficients that were higher for measures tapping similar constructs (absolute value, r(s)=46; P<.01) but lower for measures of dissimilar constructs (absolute value, r(s)=.07-.26; not significant). In addition, the CANS discriminated between levels of injury severity, functional independence, and overall functioning (P<.01). In terms of predictive validity and responsiveness, CANS scores at inpatient rehabilitation discharge predicted the participant's functioning 6 months later. CONCLUSIONS: These results show the CANS is a valid and responsive tool and, together with its previously shown reliability, is suitable for routine application in clinical and research practice.